1. Dr. B.L.Gochar, M.S. Laparoscopic Surgeon Anurag Hospital & Research Centre 7-C-34, Mahaveer Nagar III, Kota Raj. - (Laparoscopic Cholecystectomy) - - - , - , (= - = ) - - , ,

2. - (Incidence of Gall Stones) , , . , , (Flatulent) (5 S - ) Fat, Fertile, Flatulent, Female of Forty (-5 F) Flirt , 2-3 % - - - (History of Cholecystectomy) -1882 100 , 12 , 1985 - - 1986 1987 - , 1992 3. 1999 Society of American Gastrointestinal Surgeons (SAGES) - , , (Peritoneum) 7-10 .. 2.5-5 .. , , (Fundus, Body, Infundibulum & Neck) - 60 .. 300 .. S , (Cystic Duct) - (Hartmann pouch ) - (Right and Left Hepatic Duct) - (Common Hepatic Duct) - - , , ( Duodenum) - , , , (left hepatic, common hepatic, gastroduodenal, or superior mesenteric arteries) - - 4. - (Cystic Duct) - (Common Hepatic Duct) (Common Bile Duct) 1-5 .. 3-7 .. , - (2 .. ) 5-9 .. - (Lesser Omentum) (Portal vein ) (common hepatic artery) (Inferior Vena Cava) (Pancreas) (Duodenum) , (Triangle of Calot) (Dissection) (Comman Hepatic Duct), (Cystic Artery) (Cystic Duct) (Lymph node) - (Ducts of Luschka) , , , , ! ! ! , - , , ( Cholecystitis, Pacreatitis, Jaundice & 5. Choledococystitis) - (Precipitate) - - -- - (Indications of Lap Chole) - , - - - (Lap Chole) - .. (Chronic obliterated Cystic duct) (Nonfunctioning Gallbladder)) (Calcified or Porcelain Gallbladder) 10 .. ( Polyp) (Gallbladder Trauma) (Anomalous junction of the Pancreatic and Biliary ducts) 6. (Biliary colic) - 10 , , , , , (Acute cholecystitis) 72 72 (Inflammatory changes) 4-6 (Complex gallbladder disease) (Gallstone pancreatitis) ...., ...., .... - (Preoperative ERCP with sphincterotomy) .... - (Postoperative ERCP with sphincterotomy) (Laparoscopic intra- operative cholangiogram with laparoscopic common bile duct (CBD) exploration) - (Open CBD exploration and T-tube placement) - , - - , - (Acalculous cholecystitis), - (Open CBD exploration and T-tube placement), (Organ Transplant) 7. - (Contraindications of Lap Chole) (Absolute) , - (Obstructive Pulmonary disease or Congestive Heart Failure) CO2 (Carbon dioxide Pneumoperitoneum) , (Laparotomy) - (Lymph nodes) - (Obesity), (Pregnancy), (Gangrenous Gallbladder), (Empyema of the Gallbladder), - ( Bilio-enteric fistulae), ( previous upper abdominal procedures), , - ( Coagulopathy) - 8. - - 0.22 0.4 % 5% , ( Adhesions) (Hemorrhage) (Port) (Retroperitoneal Hematoma) (Hypotension) - cauterizing or clipping) , - - - , (Haemostatic) (Postcholecystectomy syndrome) - (40 % ) , , (dyspepsia, flatulence, bloating, right upper quadrant pain, and Epigastric pain) , , (sphincter of Oddi dysfunction) (Comman Bile Duct Injury or Spasm) - 3-7 , , , , (ascites), (anorexia) (Ileus) (spasm) 9. - .... - (Preoperative ERCP with sphincterotomy) (Surgical Biliary reconstruction ) - , (Deep Vein Thrombosis) - - , - - - , - (Pre-Operative Clinical Checkup & Investigations) (Clinical Checkup) - , (, , , ...., , , ( Drug Allergy), - (Stroke) , (, , ) - , , , 2 , (Lungs), , (Spleen) - , ..., ..., , .., .., , , , , ..., , , ..., , , ... , 2 , ..., .... 10. 4 4 , (Spinal Anesthesia) , , , 6 - , -- , , , , , 1. - , -, ... 2. (Nipple line) (Mid Thigh) (Anterior superior iliac spine) - ( Electric Cautery) 11. 3. - (EndoTrachial Tube) 4. (Ports) , (Laparocsope with Light Source & Camera) -(Monitors) - 5. - - , , (Omentum) CO2 CO2 (Embolus) CO2 15 , 12. - - 1 .. , (Pelvis) 3-4 .. - (Saline) (Abdominal Cavity) , -, ( , ) 2 3 CO2 1.2 .. 11 .. - - , CO2 .. 15 1.2 .. (Longitudinal incision) 0 . U (Forceps) (Peritoneum) 11 .. - - CO2 15 .. 30 - (Laparoscope) (xiphoid process ) 1.2 .. 11 .. 13. (falciform ligament) 11 .. (Port) 5 .. 5 .. 5 .. , 5 . - - 5 .. ( Grasping Forceps) (Drain) - - - - , , - , , , (Grasper) , 14. 15. (Reverse Trendelenburg Position) , -, , - - - - - - - (Cystic duct) (Cystic Artery) (Dissection) ( Distal) (Proximal End) (Stump) (Liver Bed) - - (Basket) - (Umbilicus Port) - - - (Suction) , 16. CO2 - 1999 - - - 12000 - . .., M.S.